Preferred Method of Contact:*
PhoneEmail

Are you seeking medical marijuana to treat symptoms caused by a motor vehicle accident, slip and fall, medical malpractice, workplace injury?
YesNo

Province:*
AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon

Are you 25 years of age or older?*
YesNo

Do you have a documented medical condition?*
YesNo

Do you currently medicate with Cannabis?*
YesNo

Are you a Veteran of the Canadian Forces:*
YesNo

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